AT SILVER HOME CARE, WE ARE COMMITTED TO PROTECTING THE PRIVACY AND SECURITY OF YOUR PERSONAL HEALTH INFORMATION. OUR SILVER HOME CARE UNDERSTANDS THAT YOUR PERSONAL INFORMATION IS SENSITIVE, AND WE TAKE THE SAFEGUARDING OF IT VERY SERIOUSLY. THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) REQUIRES OUR SILVER HOME CARE TO PROVIDE YOU WITH THIS NOTICE IN WRITING EXPLAINING OUR PRIVACY PRACTICES. WE WOULD LIKE YOU TO KNOW THAT WE ADHERE TO ALL HIPPA REGULATIONS AND THAT WE HAVE IMPLEMENTED POLICIES AND PROCEDURES TO PROTECT YOUR PERSONAL HEALTH INFORMATION.

AT SILVER HOME CARE WE MAY COLLECT PERSONAL INFORMATION ABOUT YOU, SUCH AS YOUR NAME, ADDRESS, PHONE NUMBER, EMAIL, AND MEDICAL HISTORY. THIS INFORMATION IS UTILIZED TO PROVIDE YOU WITH THE HOME CARE SERVICES THAT YOU HAVE REQUESTED. WE MAY SHARE YOUR PERSONAL INFORMATION WITH OUR EMPLOYEES, CONTRACTORS, AND OR OTHER SERVICE PROVIDERS WHO NEED TO HAVE ACCESS TO THIS INFORMATION TO PROVIDE YOU WITH OUR SERVICES. OUR SILVER HOME CARE WILL NOT DISCLOSE OR SHARE YOUR PERSONAL INFORMATION TO ANYONE ELSE WITHOUT YOUR CONSENT, EXCEPT AS REQUIRED BY LAW.

FEDERAL LAW CODE 45 CFR § 164.512. OUTLINES THE CIRCUMSTANCES UNDER WHICH PROTECTED HEALTH INFORMATION(PHI) CAN BE DISCLOSED AND WITHOUT AN INDIVIDUAL'S CONSENT. THESE CIRCUMSTANCES INCLUDE:

1. TREATMENT, PAYMENT, AND HEALTHCARE OPERATIONS IF IT IS NECESSARY AND RELEVANT TO THOSE ACTIVITIES.
2. PUBLIC HEALTH ACTIVITIES SUCH AS DISEASE SURVEILLANCE, INVESTIGATION, AND REPORTING.
3. LAW ENFORCEMENT PURPOSES SUCH AS SUCH AS TO COMPLY WITH A COURT ORDER OR SUBPOENA, TO IDENTIFY A SUSPECT OR FUGITIVE, OR TO PREVENT A SERIOUS THREAT TO PUBLIC SAFETY.
4. RESEARCH PURPOSES IF CERTAIN CONDITIONS ARE MET, SUCH AS OBTAINING CONSENT FROM THE INDIVIDUAL OR OBTAINING A WAIVER OF AUTHORIZATION FROM AN INSTITUTIONAL REVIEW BOARD.
5. HEALTH OVERSIGHT ACTIVITIES SUCH AS AUDITS, INVESTIGATIONS, AND INSPECTIONS OF HEALTHCARE PROVIDERS AND PLANS.

YOU HAVE THE RIGHT TO ACCESS YOUR PERSONAL HEALTH INFORMATION, REQUEST A CORRECTION, AND FILE A COMPLAINT IF YOU BELIEVE YOUR PRIVACY RIGHTS HAVE BEEN VIOLATED. IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR PRIVACY PRACTICES, PLEASE DO NOT HESITATE TO CONTACT US AT THE ADDRESS PROVIDED IN THIS FORM.

AT SILVER HOME CARE, WE ARE COMMITTED TO PROVIDING YOU WITH HIGH-QUALITY NON-MEDICAL HOME CARE SERVICES. WE WANT TO ASSURE YOU THAT YOUR PERSONAL HEALTH INFORMATION IS SAFE WITH US. YOUR PRIVACY AND CONFIDENTIALITY ARE OF UTMOST IMPORTANCE, AND WE WILL NOT USE OR DISCLOSE YOUR PERSONAL INFORMATION FOR ANY PURPOSE OTHER THAN DELIVERING THE SERVICES YOU NEED AND HAVE CONSENTED TO RECEIVE.

WE ADHERE STRICTLY TO PRIVACY REGULATIONS AND ONLY SHARE INFORMATION WHEN LEGALLY REQUIRED OR WITH YOUR EXPLICIT PERMISSION. IF YOU HAVE ANY QUESTIONS ABOUT OUR PRIVACY PRACTICES OR WISH TO DISCUSS YOUR RIGHTS CONCERNING YOUR PERSONAL INFORMATION, PLEASE DO NOT HESITATE TO REACH OUT TO US.

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PLEASE SIGN BELOW TO ACKNOWLEDGE YOUR RECEIPT OF OUR PRIVACY PRACTICES.